Specialist Fraud Prevention Personal Insurance (m/f/d), 60-100%

About the job

Health Insurance Solutions AG is a service support centre for health, social and private insurers founded in 2024. With high-quality and efficient services from a single source, we support our customers and partners in optimising their claims processes and successfully developing further in the insurance market. To strengthen our Fraud Prevention team, we are looking for a specialist as soon as possible or by arrangement

Specialist Fraud Prevention Personal Insurance (m/f/d), 60-100%

Your Role

In fraud prevention for personal insurance, you take on a responsible and demanding role at the interface of insurance benefits, law and investigations. With your analytical thinking and your instinct for complex matters, you help to detect abuse early and make well-founded decisions. You conduct investigations independently, coordinate investigative measures and maintain close contact with internal and external stakeholders. In this way, you make an important contribution to fair and sustainable claims assessment.

For this position, we are looking either for an experienced professional 100% with expertise in health and personal insurance (KVG, UVG and KTG) or two professionals each with 60%, one specialising in health insurance (KVG) and one specialising in personal insurance (UVG/KTG).

Your Tasks

• You independently handle claims with suspected abuse in health and personal insurance (health insurance and/or accident and daily sickness allowance insurance) and carry out the necessary investigations.
• You analyse complex matters, evaluate relevant information and use data analyses to uncover irregularities.
• You plan, coordinate and accompany appropriate investigative and clarification measures and assess the results of surveillance.
• You conduct discussions and negotiations with claimants, service providers, legal representatives and other stakeholders, professionally and confidently representing the interests of the insurer.
• You prepare sanction decisions and criminal complaints with professional expertise and accompany criminal and arbitration proceedings.
• You advise and support internal and external stakeholders on technical and legal issues related to fraud prevention and abuse prevention.
• You convey your expertise in presentations and training sessions and contribute to raising awareness of fraud risks.

Your Profile

• At least 3 years of professional experience in claims management for health and/or personal insurance (KVG and/or UVG and KTG) or in fraud prevention.
• Further training in private and/or health insurance, for example as an insurance specialist with a federal certificate, insurance economist HF or health insurance specialist with a federal certificate is an advantage.
• Strong analytical skills as well as experience in evaluating and interpreting complex data and contexts.
• High decision-making and assertiveness skills as well as the ability to appear confident even in demanding discussion and negotiation situations.
• Very good written and spoken German skills.
• Good knowledge of French is an advantage and facilitates communication with customers, service providers and other stakeholders in Western Switzerland.
• Independent, structured and responsible working style with high initiative.
• High integrity, discretion and a pronounced instinct for complex matters and risk-relevant contexts.

What We Offer You

• A varied and responsible role with a lot of personal responsibility.
• A motivated and committed team with flat hierarchies and short decision-making paths.
• A modern working environment in the latest office premises in the heart of Bern.
• Attractive development opportunities, numerous benefits and the possibility to work from home.

Are you ready? Then let’s grow together! Send us your application with CV, diplomas and references via jobs.ch. We look forward to getting to know you!